Who will lead the anti-corruption agenda in the health sector?

The conduct of election of members to the Medical Council of India in 2013 and its subsequent actions over the past year have underlined the brazen corruption in the regulatory body. Developments in the health ministry raise doubts over whether these issues will be tackled at all. A round up:

The removal of Dr Harshvardhan from the helm of the health ministry may merely be to give him more room to focus on the Delhi assembly election campaign for the BJP, but there appears to be an apprehension in several quarters that the shift, whether intentionally or otherwise, will be a setback to the attempts to free the medical sector from corruption.

In June 2014, shortly after assuming office, the minister had told The Indian Express that he was “more aware than anybody else of the corruption that is eating into the entrails of every aspect of governance, including the health system” and had acknowledged that the Medical Council of India was indeed a corrupt body.

Former Minister for Health and Family Welfare, Dr Harshvardhan. Pic: Press Information Bureau

A couple of months later, in September, the health minister referred yet again to a “radical transformation” in the way that the MCI, the highest regulatory body in the Indian health sector, functioned. At a press conference marking the completion of his first 100 days in office, the minister said that he had initiated a review in order to examine ways to ensure that regulation of medical education and its practice were marked by transparency and integrity.

The MCI story

The Medical Council of India is a statutory body established in 1933 and entrusted with the responsibility of establishing and maintaining high standards in medical education and practice. It registers doctors to practice in India, gives accreditation to medical colleges, grants registration to medical practitioners, and monitors medical practice in India.

The sordid state of affairs within this apex regulatory body, however, did not need the minister’s references to make a mark on public consciousness. The council has been embroiled in controversy for well over a decade now and one can trace it back to March 2001, when the Delhi High Court ordered the dismissal of Dr Ketan Desai, then president of MCI, from his post on charges of corruption. He however returned to the MCI in 2009 and was elected “unopposed” as President.

In 2010, Desai was caught by the CBI, accepting a bribe from a medical college in Punjab which was looking to enrol students in excess of sanctioned capacity. Soon afterward, the UPA government under pressure dissolved the Medical Council on grounds of widespread corruption and appointed a seven-member Board of Governors (BOG) through an ordinance. That same year, Desai’s medical registration was also cancelled by the MCI.

A still from a 2011 news video on Youtube. Courtesy: CNN IBN

In October 2013, the same UPA government did a volte face and abolished the above BOG; the health ministry now announced the establishment of a new MCI, with elected/nominated members from different states/universities in accordance with the Indian Medical Council (Amendment) Ordinance, 2013. These nominations were made by the governors of the different states in their capacity as chancellors of the universities.

Ketan Desai also managed to get himself nominated in this round as a member of MCI from Gujarat University even as his licence to practise medicine remained suspended by the council. When questioned on this by Julio Ribeiro, chairman of the Public Concern for Governance Trust in Mumbai, the Governor’s office in Gujarat responded citing the reported ‘opinion’ of Justice AM Ahmadi, former Chief Justice of India, that the MCI has no jurisdiction or authority to suspend the registration of any doctor registered with any state medical council.

In December 2013, the freshly constituted MCI held elections for the post of President, Vice-President and Executive/Post graduate committee members. The manner in which these elections were conducted came under severe attack, in particular from an NGO, People for Better Treatment (PBT India), led by veteran physician and health activist, Dr Kunal Saha.

A petition for justice

PBT India filed a Public Interest Litigation (PIL) in the Supreme Court of India, alleging gross irregularities and rigging in the elections under the influence of the disgraced former president, leading to all his cronies being elected “unopposed” at the top positions in the MCI.

Based on a formal complaint lodged with the health ministry by a member of the Council itself, the PIL describes in detail how, at a dinner party hosted by Desai on the eve of the elections, a printed list was circulated containing the names of members, all close associates of Desai, who would be elected the next day to the key posts. The list was minute in detail, down to the names of those who would nominate these individuals (proposers) and those would support the nominations (seconders).

At least 17 members thus elected belonged to the former council that had been dissolved on grounds of rampant corruption, as was pointed out in a written memorandum from PBT India to Ghulam Nabi Azad, then health minister.

It is also interesting that at the same time, the erstwhile Union government transferred the Health Secretary Keshav Desiraju from his post in a controversial move, leading several former bureaucrats and eminent citizens to question the decision. According to sources in the higher echelons, Desiraju met with his fate owing to his reluctance to accept the fresh induction of the tainted Desai in the MCI.

Soon after election of the office holders and committee members, the MCI went on to cancel seats in various medical institutes in a reckless manner, allegedly without following any due procedures or obtaining the consent of the General Body.

In view of the above irregularities, the PIL sought the immediate dissolution of the council, a CBI investigation into the rigged elections and prosecution of those complicit in the process, and amendment of Section 3 of the Indian Medical Council Act, that allowed a large number of corrupt doctors to be “nominated” through sinister political connections for membership in the MCI.

It was not just PBT India that accused the MCI of reverting to its older corrupt ways. A letter written to the CBI by the Joint Secretary in the Ministry of Health and former CVO, Dr Vishwas Mehta acknowledges that the Chattisgarh Nagrik Sangharsh Samiti, Raipur had also written to the health ministry alleging that the MCI was granting seats to private medical colleges for money, while reducing seats in other medical colleges without basis. The Samiti also referred to the involvement of the MCI with mafia groups.

Meanwhile in Kerala, the CBI conducted raids in the offices of the MCI, several of its top officials as well as the Principal of a private medical college, following charges that the college’s application to get its post-graduate seats approved by MCI was granted, even though it was filed after the expiration of the deadline.

Hope floats, only to fade away

Given the background, therefore, Harshvardhan’s allusions to corruption in the council hardly came as a surprise. In fact, the minister also came down aggressively on the decision of the council to manipulate the number of seats available in medical institutes. A PIB release dated 2 August, 2014 pointed out that the MCI’s decisions had led to a loss of 1,170 medical seats for the academic year 2014-15.

The health minister accused the MCI of taking an adversarial stand on students while cancelling seats in medical colleges citing their failure to meet the MCI’s requirements. In many cases, these “deficiencies” had little to do with medical education per se and were purely infrastructural, such as problems with air-conditioning, or the thickness of the partition walls in buildings.

“For years it was an open secret that the MCI was looking the other way as medical colleges rampantly flouted regulations. Suddenly, this year they have struck. But why are they not punishing the managements?” asked the minister.

However, notwithstanding the high rhetoric on cleaning up the regulatory body, not much can be cited in terms of concrete steps taken by the Ministry even while Harshvardhan was in office. No official response was sent to formal complaints lodged by PBT India against several top leaders of the present MCI in view of their corrupt records. The NGO, that had initially welcomed the appointment of Harshvardhan and lauded his intentions, was becoming increasingly disillusioned.

In a post on its website in early October, it questioned the willingness and ability of the new government to tackle the issue: “Almost six months have passed since the new government came to power and there is absolutely no sign that the corrupt medical education and healthcare delivery system are likely to change, as except some boisterous speeches by the newly elected BJP leaders, we see no evidence that Dr Vardhan and his ministry are ready to walk the walk for solving the healthcare crisis.”

Things worsened when it came to light that the Chief Vigilance Officer (CVO) in the MCI, H.K. Jethi, was forced to seek repatriation to his parent cadre as he was “feeling scared” having been subjected to “physical harassment” while investigating complaints of corruption in the body. In his letter to the Ministry, he wrote, “MCI is using all pressure tactics for destabilising the functioning of the Vigilance Commission,” concluding that “the atmosphere is not congenial for me to perform without fear, which I feel is the foundation for effective vigilance administration.”

Joint Secretary Mehta in his letter to the CBI also took note of this and claimed that the MCI administration had not extended cooperation to the CVO and had in fact shown a “vindictive attitude” towards him, seemingly “functioning in an autocratic manner” for protection of “some vested interests”.

Harshvardhan’s decision to concede to Jethi’s wish without initiating any investigation into the issues raised by the latter had attracted some criticism and parallels were drawn in media with the instance when he had removed Sanjiv Chaturvedi, the CVO of the All India Institute of Medical Sciences.

However, shortly before he was moved from the health ministry, he clarified his stance and said that he had merely forwarded Jethi’s request to the Department of Personnel and Training (DoPT). He reiterated his commitment to “to reform medical education and root out corruption in all institutions” and referred to the committee of experts that he has set up to review the Medical Council of India Act.

With his focus shifting elsewhere now, it remains doubtful how seriously the same agenda will be taken up by his successor. The Aam Aadmi Party has already criticised the Prime Minister’s choice of. Harshvardhan’s successor. JP Nadda, the newly appointed health minister, is the same man who is believed to have pressured the former minister into removing Chaturvedi in August 2014. The latter had raised an alarm about various instances of corruption at the Institute, including one that reportedly involved a senior official from Nadda’s home state.

Sections of media have also speculated that the switch of portfolios has been, at least in part, triggered by the former minister’s thrust on scaling up graphic warnings on tobacco packets, ruffling several feathers in the tobacco lobby.

Whatever may be the reasons behind the portfolio redistribution, Harshvardhan’s distancing from the Health Ministry could prove to be a shot in the arm, if it was needed at all, for the corruption-ridden Medical Council of India, which he had promised to reform.

The only ray of hope comes from the fact that the Supreme Court has taken cognizance of the matter and on 3 November, issued notices to the Centre and the MCI, asking them to respond to the allegations in the PIL filed by PBT India.

In an email to India Together, Dr Kunal Saha, President of PBT India, writes, “We are very pleased that the highest court of the land, prima facie, has agreed that the MCI was formed through a botched election under the influence of the same Desai and his medical cronies. Pervasive corruption in the medical council is common knowledge today and all doctors are well aware of it. Unfortunately, under the present condition, even the honest doctors have remained silent spectators on the sideline making the situation even worse. My hope is that these "good" doctors will now step forward to cleanse the rot deeply rooted in the Indian healthcare delivery system. And it must start with cleansing the MCI that has the supreme authority to regulate medical education and the healthcare delivery system.”